Imagine the following fictional scenario. I am midway through a session with a woman who is describing her weekend away with friends. Something in her voice and expression reminds me of my initial impression of her, several years ago, when it struck me that she looked very much like a frightened animal. This thought occurs to me at the point in her conversation when she is describing how stressful she found her weekend. The friends she was staying with were among her closest, yet her continual exposure to the demands of relationships without any bolt hole left her feeling overexposed and spent with exhaustion.

Imagine the following fictional scenario. I am midway through a session with a woman who is describing her weekend away with friends. Something in her voice and expression reminds me of my initial impression of her, several years ago, when it struck me that she looked very much like a frightened animal. This thought occurs to me at the point in her conversation when she is describing how stressful she found her weekend. The friends she was staying with were among her closest, yet her continual exposure to the demands of relationships without any bolt hole left her feeling overexposed and spent with exhaustion.

This cause of her stress has become a familiar landmark in our work together and the subject of considerable scrutiny. At root it begs the question: why can she not feel deeply at ease when with others, especially when those others are well known and much loved? Why is it so difficult to simply be her own person in any relationship? Evidence of this difficulty exists within as well as anecdotally outside of the consulting room. In our therapeutic relationship I am often struck by the feeling of her absence more than presence. It is as if she is afraid to leave her imprint in the room. She often waits for me to lead the way, then follows with imitation or agreement. Too rarely is there any sense of being with someone robustly "other".

And yet, beneath this collusive exterior, there is within this woman a painful knowledge of what she calls "my hidden Me". Herchildhood memories recall a little girl who was vibrant and effusive, bursting with her own life force. Her earliest memories are treasured scraps of the sensual and immediate: the feel of toes oozing and squelching in wet seaside sand, a velvety frock in a dressing-up box, the scratchy roughness of bark when climbing to her favourite place in an old apple tree. All moments of an exuberant aliveness. These memories ended when she was six years old and her world turned upside down. Her mother suffered a stroke and became severely disabled. Her father's distress made him irritable and snappy with her, and she soon learnt that the world was loving towards her only when she fitted in with what others wanted her to be and do. Gradually, the vibrancy of her nature became more hidden from view.

There is a paper by Winnicott called Ego Distortion In Terms Of True And False Self. In it he explores what he calls our need for both "true" and "false" selves. According to Winnicott, the "true self" first reveals itself early on in life through spontaneous play. If, argues Winnicott, our early imaginative "gestures" are welcomed and given root room, then our "true self" can develop and flourish. We will then carry within us an experience of aliveness essential for our mental health. Yet at some stage in our development, argues Winnicott, we also need to develop a "false self" in order to fit in with the compromises and conformities that are part and parcel of any family and wider social life. In an ideal world, we grow up with a conscious and working partnership between the two: balancing the need to fit in with the world around us with our need for authenticity and spontaneity.

Yet the world is real and many people suffer deeply from having had their "true self" gestures repeatedly rejected. The result is often an overidentification with what Winnicott would call their "false self": fitting in to external demands in order to feel secure. When this imbalance occurs, people describe feeling empty. They also tend to keep intimacy at arm's length. As one patient said: "How can I have relationships with people when I don't feel real myself?" Too readily compliant and too unable to trust their own instinctive and spontaneous responses, the world of intimacy becomes an unknown minefield. Often, it is this kind of scenario which finally triggers some degree of breakdown.

In analytic work, when someone feels empty for "false self" reasons, the challenge and need is to redress the balance. With someone like the imaginary woman above, the first task is to locate the "false self": understand why it got out of hand, recognise that like some unruly plant it is taking up too much room. Then it is vital to get back in touch with something that makes us feels alive. A memory, piece of music, landscape, seascape. Many people find that creating something from themselves facilitates this process: painting, working with clay, keeping a diary. Doing anything that demands a spontaneous, authentic response becomes a way of pruning back the "false self" overgrowth. The fear of doing so is often huge, but the desire within each of us to meaningfully exist rather than just react to our world is fortunately usually even greater.